P645: THE INFLUENCE OF ACTIVE CARDIAC MONITORING WITH REMOTE CONTROL ON THE SURVIVAL OF PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA, RECEIVING IBRUTINIB.
Authors: E. Emelina, G. Gendlin, I. Nikitin
Journal: HemaSphere (2022)

Background: Survival of chronic lymphocytic leukemia (CLL) patients receiving ibrutinib (Ib) is influenced by many factors, among which cardiovascular disease, both in history and during treatment with Ib, is of great importance. Aims: To assess the impact on 5-year overall survival (5-OS) of patients CLL treated with Ib two options for dynamic monitoring by a cardiologist: standard cardiac monitoring (SC) and active cardiac monitoring with remote control (ACM). Methods: We observed in dynamics for 5 years’ period 217 patients with CLL, constantly receiving therapy with Ib 420 mg/day. In the ACM group (n=89), in addition to the standard examination, every week or more often using messengers, we did active medical monitoring of the patient’s symptoms and well-being, assessment of blood pressure and heart rate, control of cardioprotective medicines taken, correction of the therapy, calling patients for examination and additional examination. The remaining 128 patients were examined in dynamics, but did not support remote control, constituting the SC group. The age of patients in the ACM group and in the SC group did not differ and was 66.0 (60.0–70.0) years and 66.0 (59.0–74.0) years, respectively (p = 0,39). There were slightly more men in the SC group (68.8%) than in the active cardiac monitoring group (53.9%), p = 0.026. The proportion of patients with CLL with the number of pretreatment lines from 0 to 2 (median -1) in the ACM group was 52.7%, in the SC group it was 58.1%; with the number of lines from 3 to 12 (median - 4) in the AKM group - 47.3%, in the SC group - 41.9% (p = 0.53). The AKM and SC groups did not differ in the results of the Geriatric 8 scale, Charlson index, and echocardiography parameters at visit 1. In the ACM group, there were more patients with cardiac problems: with arterial hypertension (AH) (p < 0.0001) and atrial fibrillation (p < 0.0001), receiving anticoagulants (p < 0.0001), a comparable number of patients with coronary artery disease. Results: In the ACM group, 70 out of 77 (90.9%) patients with CLL and AH achieved a stable level of target blood pressure values, in contrast to the SC group - 26 out of 66 (39.9%), p < 0.0001. Significantly more events requiring cardiac surgery (stenting of the coronary arteries, installation of a pacemaker) were detected in the ACM group – 12, versus 0 in the SC group (p = 0.0004). In the ACM group, despite a more pronounced cardiac comorbidity, 5-OS was significantly better, than in the SC group in both men (p < 0.0001) and women (p < 0.0001) with CLL and in patients older than 70 years old (p = 0.0004). 5-OS was also better in the ACM group than in the SC group in patients with CLL with a median number of previous lines of therapy equal to 1 (p<0.0001) and in patients with a median number of chemotherapy lines equal to 4 (p<0.0001), in patients with genetic abnormalities (p=0.004) and pretreated with fludarabine and/or anthracyclines (p < 0.0001). Summary/Conclusion: Early detection and correction of cardiovascular complications/events, achievement of stable target blood pressure values, constant monitoring of cardioprotective treatment in the ACM group explain the statistically highly significant differences in 5-OS in patients with CLL who are on constant Ib therapy. Conducting active cardiomonitoring with remote control makes it possible to achieve higher rates of total 5-OS in patients with CLL receiving Ib.